Impact of Age at Diagnosis on Prostate Cancer Treatment and Survival
Impact of Age at Diagnosis on Prostate Cancer Treatment and Survival
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DOI：
10.1200/jco.2010.30.2075
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发表时间：
2011-01-10
影响因子：
45.3
通讯作者：
Cooperberg, Matthew R.
中科院分区：
文献类型：
--
作者：
Bechis, Seth K.;Carroll, Peter R.;Cooperberg, Matthew R.
目的老年男性更容易被诊断为高危前列腺癌，总体生存率较低。因此，年龄往往在治疗选择中发挥作用。然而，年龄，疾病风险和前列腺癌特异性生存率之间的关系还没有很好地established.Patients和MethodsWe研究了男性在前列腺癌的战略泌尿研究奋进（CaPSURE）数据库完整的风险，治疗和随访信息。通过使用经验证的前列腺癌风险评估（CAPRA）评分确定高风险患者。竞争风险回归用于确定年龄对癌症特异性生存的独立影响。我们还分析了局部治疗对老年男性高危疾病生存率的影响，结果在所有，26%的男性年龄>= 75岁的高危疾病（CAPRA评分6至10）。不同风险分层的治疗随年龄的变化而明显不同;老年男性更可能接受雄激素剥夺单药治疗。单独控制治疗方式，或治疗和风险，年龄不能独立预测癌症特异性生存。此外，控制年龄，合并症，和风险，老年男性高风险肿瘤接受局部治疗的死亡率降低了46%，与那些treated conservatives.ConclusionOlder患者更有可能在诊断时有高风险的前列腺癌，不太可能接受局部治疗。事实上，在患有高危疾病的老年男性中，潜在治愈性局部治疗的使用不足可能部分解释了不同年龄层癌症特异性生存率的差异。这些发现支持根据疾病风险和预期寿命而不是年龄来决定治疗。J Clin Oncol 29：235-241. (C)2010年美国临床肿瘤学会
PurposeOlder men are more likely to be diagnosed with high-risk prostate cancer and to have lower overall survival. As a result, age often plays a role in treatment choice. However, the relationships among age, disease risk, and prostate cancer-specific survival have not been well established.Patients and MethodsWe studied men in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete risk, treatment, and follow-up information. High-risk patients were identified by using the validated Cancer of the Prostate Risk Assessment (CAPRA) score. Competing risks regression was used to identify the independent impact of age on cancer-specific survival. We also analyzed the effect of local treatment on survival among older men with high-risk disease.ResultsIn all, 26% of men age >= 75 years presented with high-risk disease (CAPRA score 6 to 10). Treatment varied markedly with age across risk strata; older men were more likely to receive androgen deprivation monotherapy. Controlling for treatment modality alone, or for treatment and risk, age did not independently predict cancer-specific survival. Furthermore, controlling for age, comorbidity, and risk, older men with high-risk tumors receiving local therapy had a 46% reduction in mortality compared with those treated conservatively.ConclusionOlder patients are more likely to have high-risk prostate cancer at diagnosis and less likely to receive local therapy. Indeed, underuse of potentially curative local therapy among older men with high-risk disease may in part explain observed differences in cancer-specific survival across age strata. These findings support making decisions regarding treatment on the basis of disease risk and life expectancy rather than on chronologic age. J Clin Oncol 29:235-241. (C) 2010 by American Society of Clinical Oncology